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0;,\ f APPLICATION FOR SANITATION PERMIT Permit i" (Complete in Duplicate) Date Issue�__,-5_�____.7.� Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 49. JOB ADDRESS ANYC ION ="'"�`---7-��- ----- -------------------- ---�.,--- -w" ld- t/--S/3� Owners Name---- ---------- -------------------- --- --------------------------------------- Phone--------T -------- Address '� '' � `S ' -- --- Contractor's Name-- 5 /___ a ------- --•-------•------•---------•--- Phone! '" a_ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ / M tel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths J___ Lot size ---/_ ___�--_-.----------------- Water Supply: Public system ❑ Community system ❑ Private T-IDepth to Water Table _rft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe� E]rdpan Previous Application Made: Yes ❑ No %w Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,�QY , (No septic tank or cesspool permitted if public sewer a�ailable within 200 f/,� � Ma eria�'_______._____ ._._~ ________________ ____ Septic,Tank: Distance from nearest w61__��_____Distant fro f undation______ [� No. of compartments---___V,__./____.__.__Sizela___ _ 3G__Liquid prdepth------- _ ____________Capacity_ _OQ�._____ Dispos Y Field: Distance from nearest well.....( .d------Distance from foundation___._4__�_f_-__.Distance to nearest lot line __ ___r PY Number of lines----------- Length of each line-------I�ry--__._.__.Width of trent _ -��____________ Type of filter materialL_.2____________ _____Depth of filter material____.__�_d..r.__.___Total length___. __.Z.A.d_ __,_____________- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line______.__________ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------.-----Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_____-__ Lining material_____________________________________ ❑ Size: Diameter--------------------------- ----------Depth------------------------------ --------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F-1 Distance to nearest lot line- ---------------------- ----------------------•------------------------------------------------------------------------------------------ - Remodeling and/or repairing {describe): ►C• = -- II -------------------------------------------------------------------------------•--------------------------------------------.-------------------------------------------------------------...-------------------------------- --------------- -----------------------I •----------------------------------- ------------------------•----------------------------------------------------•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S::�P= rulesregulations of the San Joaquin Local Health District. (signed) lC..�--------------------------------------------------------------------------------------fir and/or Contractor) By: (Title) --------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------- -----------t--- ------------------------------------------- DATE--------- REVIEWEDBY------------------------------------------------------------------------------------------------- --------------- DATE--------------------•-•---------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----- -------------------------- -------- - - -------------- Alterations and/or recommendations-------------------------------------------- -----............ ------__---•--------------------....--------------------------------- - -----•-----------------------------------•--------•---•---•--------•--•------------------------------ ---------------------------------------------------------. ----------------------------------------------- ) FINAL INSPECTION BY---------------- - - -- ------------------------------- Date-----of%. - 5 4--------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M : Revised W-2100